Adjuvant pelvic irradiation for cervical cancer in the setting of a transplanted pelvic kidney

Abstract

Postoperative radiation therapy is often needed following resection for gynecological cancers. A pelvic kidney, whether ectopic or transplanted, is considered an absolute contraindication for radiation if the organ is left in place. A 45-year-old, immunosuppressed patient with FIGO IB1 cervical adenocarcinoma was treated with intensity-modulated radiation therapy (IMRT) to 45 Gy to the modified whole pelvis with a boost to 59.4 Gy to high-risk areas despite having a transplanted kidney in the right iliac fossa. The irradiation prevented further local failure in the pelvis at 36-month follow-up with no decrement in renal function. Radiation to the modified pelvis using IMRT while avoiding the renal allograft is technically feasible and should be offered to more high-risk patients.

Locally advanced carcinoma of the cervix associated with pelvic kidney treated with intensity‐modulated radiotherapy: Overcoming a therapeutic challenge

“…The patient suffered no recurrence or side effects to either kidney at 18 months. Mohiuddin et al treated a postoperative case of cervical carcinoma with a transplanted pelvic kidney with a dose of 45 Gy using IMRT . Twenty‐eight percent of the pelvic kidney received 10 Gy.…”

“…Mohiuddin et al treated a postoperative case of cervical carcinoma with a transplanted pelvic kidney with a dose of 45 Gy using IMRT. 12 Twenty-eight percent of the pelvic kidney received 10 Gy. On follow-up, the patient experienced relapse outside the radiation portal, which was managed with surgery and adjuvant chemotherapy.…”

Gynecologic cancers and solid organ transplantation

“…76,77 With modern radiotherapy techniques, toxicity to the graft may be minimized without compromising oncologic outcomes, although evidence for this is limited to a handful of cases. [78][79][80] Transplant recipients who receive radiation are also at increased risk for developing avascular necrosis of the femoral head due to steroids and maintenance immunosuppression, which may require modification of radiation fields. 76 In addition, data from prostate cancer suggest that radiation doses to the vulnerable distal portion of the donor ureter may be important and that minimizing the dose of radiation by maintaining a full bladder may decrease the risk of ureteral stenosis and obstruction.…”

“…The impact of systemic chemotherapies on grafts and posttransplant medications are addressed separately in another review in this series. With modern radiotherapy techniques, toxicity to the graft may be minimized without compromising oncologic outcomes, although evidence for this is limited to a handful of cases [78][79][80]. Surgery for the treatment of gynecologic cancers can range from simple hysterectomies for early stage cervical and endometrial cancers to extensive surgeries involving radical pelvic dissections and upper abdominal procedures for metastatic ovarian cancers.…”

Modified combined radiotherapy for cervical cancer in kidney transplant recipient

“…1,2 However, the presence of a pelvic kidney transplant complicates the situation as the altered anatomy must be carefully considered in radiological planning. [3][4][5][6] When implanted in the iliac position, the kidney graft is situated in close proximity to the lymph node clinical target volume (CTV) if treated with external beam radiotherapy (EBRT). Furthermore, being close enough to the cervix, the kidney transplant may be affected by significant doses of radiation delivered with brachytherapy (Figure 1).…”